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Functional Cognitive Activities for Adults with Brain Injury or Stroke

Rob Koch, BS, OTR/L
5 Hours 44 Minutes
Jan 28, 2013
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Progressing from the Clinic to the Community

Typical therapy approaches used for rehabilitation of adults with cognitive deficits due to brain injury or stroke target primary cognitive sub-skills (memory, orientation, attention, etc.) in isolation. Therapy methods normally include tabletop activities, computer training, and pencil/paper tasks to improve underlying cognitive impairment. However, the learning associated with these methods does not always translate to the world outside the clinic. Patients may become frustrated with their lack of progress or find themselves unable to perform necessary tasks once they return to their home environment.

This recording introduces an innovative, alternative, and effective approach to TBI and stroke rehabilitation. It proposes that therapists dealing with cognitive deficits conduct therapy sessions that steer away from work on primary cognitive skills in isolation and switch to having the patient perform comprehensive activities in "real-life" environments. This is accomplished by utilization of a graded sequence of functional therapy activities. The main concept behind this approach is that three global factors influence the patient's "real-life" functioning. These factors include the awareness and management of interpersonal relationships, the environment, and time constraints.

Therefore, therapy activities in this sequence have been structured to interweave the three global factors so that the patient interacts dynamically with other people, physical space, and time parameters during sessions. As the patient improves, expectations for sessions change as environmental demands increase and tasks become more complex. The levels of the sequence pertain to patients ranging from inpatient rehabilitation to those in community reintegration.Gain a better understanding of how patients' successes in cognitive rehabilitation require a multidisciplinary effort, as well as an emphasis on "real-life" activities, to achieve maximum independence.


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**Materials that are included in this course may include interventions and modalities that are beyond the authorized practice of mental health professionals. As a licensed professional, you are responsible for reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of practice in accordance with and in compliance with your profession's standards.  All members of the PESI, Inc. planning committee have provided disclosures of financial relationships with ineligible organizations and any relevant non-financial relationships prior to planning content for this activity. None of the committee members had relevant financial relationships with ineligible companies or other potentially biasing relationships to disclose to learners.  For speaker disclosures, please see the faculty biography.

Florida Occupational Therapists & Occupational Therapy Assistants

PESI, Inc. is an approved provider with the Florida Board of Occupational Therapy. Provider Number #50-399. This course qualifies for 5.7 self-study continuing education credits.

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California Physical Therapists & Physical Therapist Assistants

PESI, Inc. is recognized by the Physical Therapy Board of California as an approval agency to approve providers. This self-study lecture qualifies for 5.5 continuing competency hours.

Texas Physical Therapists & Physical Therapist Assistants

This activity is provided by the Texas Board of Physical Therapy Examiners Accredited Provider #2106032TX and meets continuing competence requirements for physical therapist and physical therapist assistant licensure renewal in Texas. This activity will provide 5.5 CCUs. The assignment of Texas PT CCUs does not imply endorsement of specific course content, products, or clinical procedures by TPTA or TBPTE. Full attendance is required; no partial credits will be offered for partial attendance.

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PESI, Inc. is a Registered Physical Therapy Continuing Education Sponsor through the State of Illinois Department of Financial and Professional Regulation, Division of Professional Regulation. License #: 216.000270. This self-study course qualifies for 5.5 CE credit hours.

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PESI, Inc. is an approved provider with the California Speech-Language Pathology and Audiology Board, #PDP 319. This course meets the qualifications for 5.5 hours of self-study continuing professional development credit for Speech-Language Pathologists or Audiologists, as required by the California Speech-Language Pathology and Audiology Board.

Kansas Speech-Language Pathologists

Approved for 6.5 self-study continuing education clock hours for Kansas licensed Speech-Language Pathologists by the Kansas Department for Aging and Disability Services.

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Rob Koch, BS, OTR/L Related seminars and products

Rob Koch, BS, OTR/L, has been in clinical occupational therapy practice for more than 30 years, working with people of all ages with a diverse range of diagnoses. He spent the first 11 years of his career in Utah working in developmental disabilities. There, he specialized in adapting activities and learning environments for people who have severe multiple handicaps, as well as creating several published software programs that provide better opportunities to actively participate in learning.

For 22 years, Mr. Koch worked in inpatient and outpatient neurological rehabilitation in North Carolina where his occupational therapy practice included extensive emphasis on promoting the skilled use of functional therapy activities to optimize the independence of patients with CVA, ABI, and SCI. this focus resulted in the creation of Functional Therapy Activities, a CD-ROM for use in adult neurological rehabilitation. He currently practices in a skilled nursing facility working with persons in rehab and long-term care with a variety of cognitive deficits.

Over the last decade, Mr. Koch has been developing a functional approach to improving the lives of patients with cognitive deficits due to brain injury and stroke. This approach – utilizing a sequence of functional, “real-life” activities to promote independence – is presented in detail in this seminar.


Speaker Disclosures:

Financial: Rob Koch receives a speaking honorarium from PESI, Inc.

Non-financial: Rob Koch has no relevant non-financial relationship to disclose.

Additional Info

Access for Self-Study (Non-Interactive) Access never expires for this product.

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  1. Examine a sequence of functional therapy activities to use with adults with cognitive deficits due to brain injury and stroke
  2. Plan therapy sessions that emphasize real-life tasks and move away from tabletop activities
  3. Select meaningful therapy activities that match the patient's interest areas and occupations
  4. Evaluate abilities and document progress by considering performance of real-life tasks in natural environments
  5. Assess how to grade and adjust the therapy environment to accommodate various levels of cognitive deficits
  6. Develop realistic caregiver instructions that support the rehabilitative process in the home
  7. Discover how this therapy approach can be applied by multiple disciplines to promote progress


  • The foundation of this approach
  • What is functional activity?
  • The three global elements of "real-life" activity
    • interpersonal awareness and management
    • environmental awareness and management
    • time awareness and management
  • Remedial vs. compensatory vs. combination approaches
  • Multidisciplinary implications
  • coordinating the effort to increase patient's independence
  • Establishing levels
  • Low-level tasks
  • Mid-level tasks
  • High-level tasks
  • Awareness and emotion
  • Progress checklists
  • Functional goal setting
  • Preparing for sessions in advance
  • Ready-made materials
  • Grading the environment
  • Relevance to patient's interests and occupations
  • Applications for the teenage population
  • Follow through in the home
  • Ideas for community reintegration
  • Level 1: Initiating the Next Step
  • Level 2: What Time is It?
  • Level 3: Looking Around
  • Level 4: Follow a Time Schedule
  • Level 5: Beyond the Room
  • Level 6: Organize the Therapy Session
  • Level 7: Out the Door
  • Level 8: Planning/Multitasking
  • Specific activities at each level
  • Contrast characteristics of activities between levels
  • Case examples
  • Time awareness and management factors
  • Environmental awareness and management factors
  • Interpersonal awareness and interaction factors

Target Audience

  • Occupational Therapists
  • Occupational Therapy Assistants
  • Physical Therapists
  • Physical Therapist Assistants
  • Speech-Language Pathologists
  • Activity Professionals
  • Recreational Therapists


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